title: [Expert consensus of the French society of geriatrics and gerontology and the French society of cardiology on the management of atrial fibrillation in elderly people].
abstract: The prevalence of atrial fibrillation (AF) increase with ageing. In France AF affects between 400,000 to 660,000 people aged 75 years or more. In the elderly, AF is a major risk factor of stroke and a predictive factor for mortality. Comorbidities are frequent and worsen the prognosis of AF. They can be the cause or the consequence of AF and their management is a major therapeutic objective. Comprehensive geriatric assessment (CGA), is required to analyse both medical and psychosocial elements, and to identify co-morbidities and geriatrics syndrome as cognitive disorders, risk of falls, malnutrition, mood disorders, and lack of dependency and social isolation. The objectives of AF treatment in the elderly are to prevent AF complications, particularly stroke, and to improve quality of life. Specific precautions for treatment must be taken because of the co-morbidities and age-related changes in pharmacokinetics or pharmacodynamics. Preventing AF complications relies mainly on anticoagulant therapy. Anticoagulants are recommended in patients with AF aged ≥ 75 years after assessing the bleeding risk using Hemorr2hages or HAS-BLED scores. Novel oral anticoagulants (NOACs) are promising treatments especially due to a lower risk of intracerebral haemorrhage. However, their prescriptions should take into account renal function (creatinine clearance assessed with Cockcroft formula) and cognitive function (for adherence to treatment). Studies including very old patients with several comorbidities in 'real life' are necessary to evaluate tolerance of NOACs in this population. The management of AF also involves the treatment of underlying cardiomyopathy and heart rate control rather than rhythm control strategy as first-line therapy in the elderly.
authors.affiliation: Société française de gériatrie et gérontologie, France. olivier.hanon@brc.aphp.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Hanon
authors.forename: Patrick
authors.initials: P
authors.lastname: Assayag
authors.forename: Joel
authors.initials: J
authors.lastname: Belmin
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Collet
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Emeriau
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
authors.forename: Françoise
authors.initials: F
authors.lastname: Forette
authors.forename: Patrick
authors.initials: P
authors.lastname: Friocourt
authors.forename: Armelle
authors.initials: A
authors.lastname: Gentric
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Le Heuzey
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D002309:Cardiology; D002423:Cause of Death; D015897:Comorbidity; D005602:France; D015577:Geriatric Assessment; D005853:Geriatrics; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000517:prevention & control; D011788:Quality of Life; D012307:Risk Factors; D012955:Societies, Medical; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control
chemical_list: D000925:Anticoagulants
keywords: French society of cardiology; French society of geriatrics and gerontology; arrhythmia; atrial fibrillation; consensus; elderly; guidelines